术前剂量密集TC治疗联合广泛性子宫切除术及盆腔淋巴结清扫在局部晚期宫颈癌患者中的应用研究

Study on the application of preoperative dose-intensive carboplatin+paclitaxel therapy combined with extensive hysterectomy and pelvic lymph node dissection in locally advanced cervical cancer patients

目的探讨术前剂量密集卡铂+紫杉醇(TC)治疗联合广泛性子宫切除术及盆腔淋巴结清扫在局部晚期宫颈癌治疗中效果。方法选取2020年1月至2022年1月在河北中石油中心医院治疗的100例局部晚期宫颈癌患者作为研究对象,根据患者最终选取的治疗方案将患者分为观察组(n=50)和对照组(n=50)。两组均给予广泛性子宫切除术及盆腔淋巴结清扫,其中观察组术前给予剂量密集TC治疗,对照组术前给予常规TC治疗。观察并比较两组围手术期指标、化疗疗效、不良反应、世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评分、无进展生存时间和总生存期。结果观察组手术时间为(210.03±41.16)min,显著短于对照组(P<0.05)。观察组术中出血量、术后排气时间、淋巴结清扫数、导尿管置管时间和术后住院时间与对照组比较,差异无统计学意义(P>0.05)。观察组化疗疗效优于对照组,其客观有效率(ORR)为82.00%,显著高于对照组(P<0.05)。两组不良反应比较,差异无统计学意义(P>0.05)。观察组治疗后3个月WHOQOL-BREF生理领域评分为(10.84±1.69)分,显著高于对照组(P<0.05);两组心理领域、社会关系领域和环境领域评分比较,差异无统计学意义(P>0.05)。观察组中位无进展生存时间为26.00个月(95%CI:23.37~28.64),显著长于对照组(P<0.05)。两组中位总生存期比较,差异无统计学意义(P>0.05)。结论术前剂量密集TC治疗联合广泛性子宫切除术及盆腔淋巴结清扫在局部晚期宫颈癌治疗中有较好的效果,可改善患者生存质量及延长无进展生存时间。

Objective To explore the effect of preoperative dose-intensive carboplatin+paclitaxel(TC)treatment combined with extensive hysterectomy and pelvic lymph node dissection in the treatment of locally advanced cervical cancer.Methods A total of 100 locally advanced cervical cancer patients treated at Hebei Petro China Central Hospital from January 2020 to January 2022 were selected as the research subjects.According to the treatment plan ultimately selected by the patients,they were divided into an observation group(n=50)and a control group(n=50).Both groups received extensive hysterectomy and pelvic lymph node dissection,with the observation group receiving dose-intensive TC treatment before surgery and the control group receiving routine TC treatment before surgery.The perioperative indicators,chemotherapy efficacy,adverse reactions,world health organization on quality of life brief scale(WHOQOL-BREF)score,progression free survival time,and overall survival between two groups were observed and compared.Results The surgical time in the observation group was(210.03±41.16)minutes,which is significantly shorter than that in the control group(P<0.05).There was no statistically significant difference(P>0.05)between the observation group and the control group in terms of intraoperative bleeding volume,postoperative exhaust time,lymph node dissection,catheterization time,and postoperative hospitalization time.The observation group showed better chemotherapy efficacy than the control group,with an objective response rate(ORR)of 82.00%,significantly higher than the control group(P<0.05).There was no statistically significant difference in adverse reactions between the two groups(P>0.05).After 3 months of treatment,the WHOQOL-BREF physiological field score in the observation group was(10.84±1.69)points,significantly higher than that in the control group(P<0.05);there was no statistically significant difference in scores between the two groups in the fields of psychology,social relations,and environment(P>0.05).The median progression free survival time in the observation group was 26.00 months(95%CI:23.37-28.64),significantly higher than that in the control group(P<0.05).There was no statistically significant difference in median overall survival between the two groups(P>0.05).Conclusions The combination of preoperative dose-intensive TC therapy with extensive hysterectomy and pelvic lymph node dissection has a good effect in the treatment of locally advanced cervical cancer,which can improve the quality of life and progression free survival time of patients.